Advanced Generation Cephalosporin

Aka: Advanced Generation Cephalosporin, Fourth Generation Cephalosporin, Fifth Generation Cephalosporin

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II. Background

  1. The fourth and Fifth Generation Cephalosporins are loosely grouped newer agents
    1. Contrast with the first to Third Generation Cephalosporins that formed discrete groups with similar antimicrobial activity

III. Medications: Fourth Generation

  1. Cefepime (Maxipime)
    1. Broad spectrum Gram-positive and Gram-negative organisms (building on Third Generation Cephalosporin coverage)
    2. Beta-Lactamase resistant organisms
      1. More AmpB beta lactamase resistant than second and Third Generation Cephalosporins
      2. Better activity against Citrobacter and Enterobacter
    3. Pseudomonas coverage (similar to Ceftazidime)
    4. Although some anaerobic coverage, not active against Bacteroides fragilis
      1. Use with Metronidazole for intraabdominal infections
  2. Ceftolozane and Tazobactam (Zerbaxa)
    1. Gram-Negative Bacteria (aerobes and Anaerobes)
    2. Multidrug Resistant Enterobacteriaceae (Ceftazidime-resistant, ESBL)
    3. Bacteroides
    4. Prevotella
    5. Pseudomonas aeruginosa

IV. Medications: Fifth Generation

  1. Ceftaroline (Teflaro)
    1. Multidrug-resistant Staphylococcus aureus
      1. Methicillin-resistant Staphylococcus aureus (MRSA)
      2. Vancomycin-intermediate Staphylococcus aureus (VISA) and heteroresistant VISA
      3. Vancomycin-Resistant Staphylococcus aureus)
    2. StreptococcusPneumonia
      1. Includes drug-resistant strains
    3. Respiratory Gram-Negative Bacteria (including Beta-Lactamase-positive Bacteria)
      1. Moraxella catarrhalis
      2. HaemophilusInfluenzae
  2. Cefiderocol (Fetroja)
    1. General
      1. Structurally similar to Cefepime and Ceftazidime
      2. Effective against multi-drug resistant Gram Negative aerobic Bacteria
      3. Indicated in complicated Urinary Tract Infections including Pyelonephritis
      4. Does not provide adequate Gram Positive or anaerobic activity
    2. Covers Multidrug-Resistant Organisms in complicated Urinary Tract Infections
      1. Escherichia coli
      2. Enterobacter cloacae complex
      3. KlebsiellaPneumoniae
      4. Proteus mirabilis
      5. Pseudomonas

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